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SAN-JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness row; here. SAWADORBUENROSTRO <br /> 4 DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> STOCKTON,CA 95203 <br /> COMMISSARY AGREEMENT <br /> Mobile Food Facility ♦ Caterer <br /> Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> 1 . To be completed by APPLICANT <br /> Business Name CREPETEA CO. Lic. Plate# 4KJ9730 <br /> Owner/Operator Name TAMTHANH TRAN <br /> Business Mailing Address 7554 PACIFIC AVE. #2012 PO BOX 692012 <br /> City STOCKTON State CAZip 95203 Bus. Ph. 2092006190 Alt. Ph. <br /> I, , hereby state that the above information is current,true and correct to <br /> the best of my knowledge and agree to utilize my approved commissary in accordance with California Health & <br /> Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use of the <br /> commissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation and penalties. <br /> Signature ( Date 5/26/22 <br /> 2. To be completed by COMMISSARY OWNER/OPERATO <br /> Commissary Name California Catering Truck wash FA# <br /> Address 730 S California St Bus. Phone 209 <br /> City Stockton Zip 95203 Owner/Operator Salvador BUENROSTRO <br /> Check all appropriate services provided: <br /> p astewater disposal W3-compartment sink Electrical hook-ups <br /> Solid wash disposal CeFood preparation 0"Toilet and handwashing <br /> CyHot & Cold water for cleaning Q-St refrigerated food O'Potable water <br /> Cl/Store dry food/supplies ��7'/Overnight parking O/ehicle wash <br /> I, , hereby state that the information I have provided is current, true and <br /> correct to the best of my knowledge,and meets the California Health&Safety Code requirements. If the food facility <br /> operator fails to comply with the conditions of this a reement, or if this agreement is modified or cancelled, the <br /> commissary w r shall not the EHD immediate) <br /> Signature Date 5/26/22 <br /> 3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co.' <br /> The commissary is located in County. The above food facility meets the <br /> commissary requirements in California Health & Safety Code. The above checked services are available at the <br /> above commissary. Please notify EHD if the status of their operating permit changes. <br /> REHS Signature Date <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br />